We propose to study a simulation-based training and systems analysis strategy to improve patient safety. Our plan and goals are aligned with AHRQ's mission and long-range objectives to reduce the high human and economic costs of preventable harms caused by health services. Our central intervention is immersive simulation-based team training with video feedback for interdisciplinary rapid response (medical emergency) teams and related situations involving the changing, non-routine patient condition. The specific aims of the project are (1) Begin to test the hypothesis that immersive simulation-based rapid response team training improves higher level individual rescue skills, attitudes and team effectiveness in simulation settings (2) Conduct in situ "crash dummy" simulations in actual rapid response team clinical units to gather data on technical, human factor, team, and organizational systems level strengths and weaknesses to support design of effective immersive training simulations and make recommendations for system change (3) collect and study detailed self-reports by immersive team simulation trainees about actual non-routine patient care events to better understand transfer of simulation training (4) link the proposed experimental studies and results to our other expanding simulation-based training courses to strengthen impact and sustainability (5) study the expansion of an interdisciplinary immersive team simulation program on organizational level variables including safety culture, infrastructure, systems changes and leadership (6) expand our work with the access grid - a new advanced networking and audiovisual technology - to include demonstrations within this collaborative agreement project (7) hold three public Chicago meetings about the project in co- sponsorship with the Metropolitan Chicago Healthcare Council to obtain feedback, disseminate lessons learned, and continue to build the infrastructure to deliver immersive team simulation in the region. A key long-term goal of the project is to build on AHRQ, other federal and national foundation funding in the past five years to create a sustainable interdisciplinary patient safety center at the University of Chicago. A second major objective is to work to institutionalize effective simulation-based team training organization- wide in one academic medical center. Finally, this project will enable us to continue to lead and implement a community-based simulation safety network in the third largest city in the country. [unreadable] [unreadable] [unreadable] [unreadable]